Busting the myth of Osteoporosis – Physiotherapy can help more than you think.

Osteoporosis – what does it mean?
Osteoporosis is a condition that affects bone density, due to a depletion of minerals like Calcium. This results in the bones in your body being more brittle and more prone to fractures, even with minor bumps or falls.

How would I know if I have Osteoporosis?
Osteoporosis is very common: it has been found to affect over 1 million Australians! 1 in 3 women, and 1 in 5 men over the age of 50 years old are affected and will suffer an osteoporotic fracture (International Osteoporosis Foundation).

There usually are no symptoms until a fracture occurs, so having regular bone scans past the age of 50 is recommended, in consultation with your GP (Osteoporosis Australia).

What type of exercise should I do if I have Osteoporosis? – Osteogenic Exercises

Osteogenic exercises – quite surprisingly, they are actually impact-based exercise training. Unlike the common belief that patients with osteoporosis should stay away from any impact to protect their bones, controlled impact training actually provides an appropriate stimulus of ground reaction force to help stimulate and promote stronger bone density.
This contradicts the commonly thought myth of having to avoid activities like jumping, running or any other impact type of activities when one has been diagnosed with osteoporosis.

Playing basketball or netball is more osteogenic than swimming or cycling – because the body has to adapt to the jumping and impact landing involved in basketball and netball. In other words, our bone production centres react to the specific type of exercise we perform (stimulus) and adapt to the amount of force our body is exposed to.

That’s where your Physiotherapist can help!

Physiotherapists are experts in exercise rehabilitation and will help tailor an exercise program that will match your physical levels and start some impact and resistance training in a safe way for you to slowly and gradually build up your bone density and lean muscle mass.

Introducing: the “Better Bones Program”

– Based on the research study LIFTMOR from Griffith University, in Queensland, published in 2017: “High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial”.

The LIFTMOR study compared a control group, who performed home-based exercises focused on prevention of falls, to a High Intensity Resistance and Impact Training (HIRIT) group, who performed twice weekly physiotherapist-supervised exercise classes for a period of 8 months.
It was found that the HIRIT group had significant improvements at multiple levels compared to the control group at follow-up.

Benefits shown from the LIFTMOR study:
– Increased bone mineral density, measured at the femoral neck and lumbar spine
– Improvement in height (reduction in thoracic kyphosis)
– Increased back extensor strength which has been associated with a reduced risk of vertebral fractures
– Improved general function

Here at Clifton Hill Physiotherapy, we have decided to apply this evidence into clinical practice and we are excited to announce the launching of Bone Health classes!

You will first have an individual consult with one of our Physiotherapists to determine your base starting level of fitness and physical capacity to ensure that the exercise and weights you will use are appropriate and safe. The Physiotherapist will also introduce you to the 4 key exercise components and familiarize yourself to the gym prior to joining classes.

Contact our physiotherapists to enquire for more information and for class registrations.

Clare qualified as a physiotherapist in 2000 from the University of the West of England. Since then Clare has worked in the UK, New Zealand and Australia in hospital and private settings. Clare has also completed a Certificate IV in fitness and clinical pilates and recently decided to return to studies and has just completed her Masters in Musculoskeletal Physiotherapy at La Trobe University.

Clare has managed a wide range of acute and chronic musculoskeletal, orthopaedic and sporting conditions over the years and particularly enjoys post-operative rehabilitation of clients.

Clare has experience in hydrotherapy, clinical pilates, and exercise prescription and utilises these skills in combination with hands-on techniques to provide an individualised management plan to promote optimal function and movement, required for returning to work and day-to-day activities. When not working Clare can be found walking the dog, in the gym, scuba diving in the bay or completing DIY projects around the house.

Congratulations to Fitzroy Football Club on another successful season, and especially to the Men’s Senior and Reserve teams who both impressively took out VAFA Premier C Premierships on Saturday at Trevor Barker Oval!!! Both teams have enjoyed spectacular seasons.

In the senior game, Fitzroy were far too strong for Old Geelong and after 8 goals in the first quarter they continued to increase their lead, finishing 15.10.100 to 4.6.30.

The Reserves was a tight game in tough conditions. Fitzroy were able to keep Old Geelong goalless for the first half before surviving a late surge, eventually winning 4.6.42 to 4.9.33.

Team physiotherapists Billy Williams and Lizzy Barnes-Keoghan, along with all of us here, would like to congratulate all teams and thank them for their efforts during the 2018 season.

ACL injuries are on the rise, and it is well known how devastating these injuries can be. Unfortunately I can personally attest to this after sustaining my own ACL injury in December last year.

What’s the big deal?
ACL – anterior cruciate ligament- is a major stabilising ligament of the knee- it controls the forward sliding motion of the lower leg and provides rotational stability with movement.

Commonly there will be accompanying bone bruising or fracture, possible cartilage or meniscus tears, or damage to other ligaments in the knee.

In the short term, the injury can result in time off work, inability to participate in sport, and prolonged rehabilitation. On average, professional elite athletes require 9 months out of sport and recreational athletes will take 12 months. Longer term, there is a high risk of osteoarthritis in people who have suffered an ACL injury, particularly if you sustained a concurrent meniscus injury. The cost of primary ACL reconstructive surgery in Australia between 2014-2015 has been estimated at $142 million, which includes surgical costs only and not the rehabilitation, burden of injury or time off work (Zbrojkiewicz, D., Vertullo, C. & Grayson, J., 2018).

How do they occur?

There is a small subgroup of ACL injuries that occur with contact- that is a direct blow to the knee- e.g. another skier collides with your leg resulting in injury.

The vast majority of these injuries however occur in a “non contact” manner. In other words, because of a landing error or twisting movement. It may be a movement that you have done countless times before, a small bump in the air prior to landing, or a timing error causing an awkward movement.

What can we do about them?

There is a growing body of evidence that many of these non-contact injuries can be prevented, and with the cost of ACL injury and the rate of injury on the rise it is crucial that we do everything that we can to avoid them.

“Neuromuscular” training programs have been shown to be effective in reducing the rates of ACL injuries. These programs are warmup routines that include balance, agility, plyometrics and landing control. Soccer, netball and AFL have all released sport specific programs that are readily available and should become part of your team’s warm up today (see links below).

A 2018 study (Webster & Hewett) showed neuromuscular training programs reduce the overall rates of ACL injuries by 50%, and in females by 67%. The research shows that the more you do these routines, the more effective the programs are at reducing the rate of injury. They are not only effective at reducing the rate of serious knee injury, but also all lower limb injuries. And if that’s not enough to get you started they have also been shown to be PERFORMANCE ENHANCING! Vertical jump and sprinting ability can improve with regular performance of a neuromuscular program (Garrison et al, 2011).

It is essential that we implement these widely from grass roots level up, and that if you’re not already doing them that you start today!

Mat pilates is a great opportunity to get a full body work out! It is suitable for all levels, and challenges the individual to work within their own body. The class draws on key pilates principles of breathing, centering, alignment, and core control to improve posture, balance, strength, flexibility and coordination which will have you moving well and feeling fantastic!

Classes are limited to a maximum of 5 participants to ensure that feedback and corrections can be given to promote optimal quality movement. Small pieces of equipment may be used including foam rollers, theraband, balls and magic circles.

Mat classes can be a great compliment to your regular studio pilates sessions and home pilates programme!

Our staff have been busy sharing their knowledge and expertise with Doctors and other Physios.

Issy has been busy presenting on two different topics this month!

Issy was asked to present to a support group of women who suffer with Endometriosis at the Epworth Hospital in East Melbourne. Issy presented on how physiotherapy can help women with pelvic pain and endometriosis. This common and debilitating illness is something our women’s health team sees frequently. They are able to help women with pain and bladder and bowel dysfunction.

The presentation went really well with many women asking questions on how they could be helped by physiotherapy. They were all amazed to hear of the self-help strategies that they could use at home with some simple steps. It was also pleasing to see so many of them came with a friend or partner to assist in managing their condition.

In that same week Issy presented her knowledge of gut focused treatment to a large group of GPs as part of their continuing education. She discussed some case studies of patients with constipation and incontinence and was able to inform the GPs of how they could manage their patients better.

There was lots of interest from the group not only on irritable bowel syndrome but also male pelvic pain and female sexual pain. The group was most interested by how physiotherapists can teach patients to regulate their bowel and be more in-control of their own health. It was exciting to see so many GPs (about 70) come out for this event, which was run by St Vincent’s Private Hospital.

Issy and Jen have also just tutored on a course on Female sexual pain for Physiotherapists and Brendon has just run 3 busy days in Bendigo teaching Health Professionals about Graded Motor Imagery and Explain Pain.

We are always striving to share our knowledge and continue our own learning.

If you have a endometriosis related pain, bladder, bowel or sexual dysfunction, consider coming in to see one of our experienced pelvic health physiotherapists who are able to sensitively navigate a management plan or chat with your GP, help is available.

Cath is a very experienced Sports (titled) Physiotherapist and Pilates Instructor and recently ran a workshop for us on the use of breath in exercise and pilates…

Effective breathing while exercising and doing Pilates helps to improve oxygenation to the body, enhance relaxation and engage the mind. Breath is often used to assist with facilitating a muscle, and the coordination of movement patterns. An exhale (breath out) is often used during the more effortful component of a movement (for example lifting or lowering a load, or moving a limb). Breathing can be regressed so that movements always occur on an exhale, with pauses in movements occurring on inhale. As people progress, and are able to achieve greater dynamic stability, breathing patterns can be progressed making movements more fluid. The focus on breath during exercise can be helpful for some to improve timing and coordinate movements. For others it can create too many things to have to attend to in addition to just doing the movement! The important thing is to ensure that you avoid holding your breath during exercise, as this can result in increased blood pressure while exercising.

Breathing also has a significant impact on the mechanics of an exercise. For example, when looking to facilitate extension through the upper back/ trunk we can time these movements with an inhalation (breath in), as the extra air going into the lungs will facilitate this movement. For some we may want to promote more stability with this movement (instead of mobility), and we may cue to do these movements on an exhalation.

Figure 1. An inhalation will facilitate getting an increased range of thoracic extension as the trunk goes upwards towards the ceiling during the Swan exercise on the Wunda Chair.

Some words to ponder which draws upon the relationship between breath and its relationship to engaging the mind –

“Breath, prana and mind are mutually and inherently related; cultivate one well and the other two will fall into line. Prana is the energy that drives life, the power that animates the body, enlivens the mind, spurs the soul. Prana is life’s inspiration, its foundation, its tenacity; it is the sure hand on the tiller, the wise voice of good counsel, the urge to health and harmony that craves to turn our bodies into havens where we can take shelter from the storms of the hectic modern world. Prana is at work every instant in every cell of every living organism.” (Robert E. Svoboda, as cited by Polestar Pilates Rehabilitation Series Course Notes, pp. 21).

Cathy Derham

References

Balance and Control Training College (2012) Foundation Level Manual (pp.42-46)

CFA Bridge magazine spoke to former Australian Netball Captain, Sharelle McMahon about incontinence amongst netballers and how she learned how to engage her pelvic floor.

An award-winning research reveals that 30 percent of women netballers experience urinary incontinence while playing Australian women’s most popular team sport. Nearly half of the women that had had babies leaked. They concluded that the prevalence of leakage while participating in netball was similar to other high impact sports and that screening for UI within netball clubs may assist symptomatic women to receive effective treatment.

Elite netballer, Sharelle McMahon remembers the day well. She was at a training session with the ANZ Championship team, the Melbourne Vixens when a physiotherapist used an external ultrasound to track how well the players were switching on their pelvic floor. “Only one of us in that group was actually activating our pelvic floor correctly, and that one wasn’t me,” said Sharelle. “The team’s physio was quite shocked. When we went through our training we were frequently asked to engage our core and our pelvic floor – that was part of the training program. So while that was a focus, we weren’t actually doing it very well.” The exercise was done about 10 years ago, and prompted Sharelle and her teammates to take action. She said the issues surrounding a weak pelvic floor do not necessarily start after having a child. The ultrasound exercise was used on her team about four years before she had her first child. Sharelle was referred to another physiotherapist, a pelvic floor specialist, who did an internal ultrasound to further identify how she was switching on her pelvic floor, and help her correctly engage the muscles.

Sharelle has participated in the pinnacle of the game, representing Australia in the Commonwealth Games between 1998 and 2010, winning gold in 1998 and 2002, and silver in 2006 and 2010. She played 118 games for Australia, won two World Championships, and was the Australian flag bearer for the opening ceremony of the 2010 Commonwealth Games in Delhi. In 2016, she was inducted into the Australian Sport Hall of Fame. She currently works as a specialist coach for the Melbourne Vixens and commentates on the sport for Channel 9.

Elite athletes such as netballers, basketballers, gymnasts, trampolinists, tennis players and runners are at increased risk of developing pelvic floor problems. This is because of the constant and excessive downward pressure that these sports place on their pelvic floor.

Sharelle believes the prevalence of continence-issues for netballers is likely due to the sport’s high impact activity involving jumping and running. “And the people playing are mostly female, so rather than it being an issue necessarily specific to netball, it’s likely something happening more broadly and it just happens to be that netball by its nature is one of those activities that has those high impact movements and a high number of female players,” she said. Sharelle returned to elite level netball about three months after she had her first child, Xavier. “So I went back into high level training pretty quickly,” she said. “Particularly with training, I had some pain associated with my pelvic floor which presented as pelvic pain and back pain. So in that year after having Xavier, I had a lot of treatment to help relieve the symptoms but also to work on strengthening my pelvic floor in particular. I was wearing a pelvic band to give myself a bit more stability as well.”

Sharelle said her session with a pelvic floor specialist helped her to properly engage her pelvic floor while she was exercising. This resulted in her being able to strengthen her pelvic floor muscles and reduce her symptoms. “You can see it on the screen and get a sense of that’s the feeling when you’re switching it on properly,” she said. Sharelle said she thought it was sad that research showed many affected by continence-related issues just resort to wearing pads or stop playing netball altogether. “For me personally, going to see someone to help in that space was incredibly beneficial. You don’t have to live with the symptoms of a weak pelvic floor. There are people who can really assist in that space,” she said. “It’s something that a lot of people are dealing with and just dealing with the symptoms is not the answer – it can lead to some much worse issues down the track.

Addressing the cause can really help.” She advises anyone going through any continence-related issues, or any issues related to pelvic or back pain to begin with seeing a physiotherapist. “Get advice to ensure you’re switching on the pelvic floor muscles correctly,” she said.

Finally the results of the LEAP study we were involved in have been published. The study was investigating management of gluteal tendinopathy and it showed convincingly that physiotherapy, which includes education and exercises, is superior to cortisone and control not only at one year but even at the short time point at 8 weeks. The Global Rating of Change was the main outcome , but the Pain outcome for physiotherapy was less at 8 weeks. (just finished the 8 week treatment program ) than 52 weeks which suggested a drop-off of benefit on pain when active treatment stopped ie they have to keep it up !!!
Well done Henry who co-authored the paper published this week and thanks to our Physios involved for their help in what was a massive task.
We have attached the paper-you can check out the pretty cool infographics with the main findings.

Not all babies develop at the same rate, and sometimes they will not develop in the same way, or the way some would consider standard. There are a number of factors that may impact on a baby’s development, including significant illness, prematurity, difficulty with or a lack of tummy time practice, and a child’s motivation to get moving. There are various milestone dates which have been developed to provide assistance to parents and health professionals when assessing a child’s progress. An example of this type of resource can be found here

(click on the growth and development tab on the left hand side of the page).

If you have any concerns regarding the development of your child, a paediatric physiotherapist is well placed to assess your child, and to provide advice on how to improve and maximise their development.

Our paediatric physiotherapist Brendan has been assessing and treating babies with developmental issues for 23 years at the Royal Children’s Hospital and in private practice, and has the necessary experience to provide the appropriate advice for your child.

For all enquiries call us on 9486 1918

BRENDAN EGAN

B App Sc (Physio) Grad Cert (Health Services Management) MBA

Brendan is an experienced paediatric Physiotherapist having spent over 23 years working at the Royal Children’s Hospital and privately treating children and adolescents with a range of conditions. He has presented at national and international conferences and is co-author and editor of a book on sporting choices for boys with Haemophilia.

Brendan’s particular expertise is paediatric musculoskeletal issues such as anterior knee pain and sporting injuries, however he also has many years experience treating children with persistent pain, haemophilia and juvenile arthritis. Other interests include advising families on developmental issues regarding concerns such as flat feet, knock-knees and torticollis/wry neck. Children and adolescents requiring rehabilitation following trauma, fractures and surgery would also benefit from Brendan’s expertise and also has experience with complex conditions such as scoliosis and burns management.